Case 59

29 -year-old woman presents with recurrent painful, sometimes draining, nodules in the perianal and inguinal region, extending to the thighs and labia majora.

History

How long have you had this problem?

They started about 4 months ago.

Look for further characteristics as you pursue the diagnosis.

Do you feel sick or weak?

I think I have a fever and I just don't feel well.

Look for further characteristics as you pursue the diagnosis.

Is it painful?

They really hurt; I can't even sit at work.

Look for further characteristics as you pursue the diagnosis.

Does anyone in your immediate surroundings (partner, family, friends) have similar problems?

No, no one has mentioned anything.

Could this be an infectious disease?

Have you ever had problems like this before?

I had hemorrhoid surgery six months ago, but my problems then were completely different.

Could this be a recurrent disease?

Are you overweight? Do you smoke or drink to excess?

I am way overweight and I smoke.

Look for further characteristics as you pursue the diagnosis.

Do you have any other health problems?

I am overweight and smoke.

Look for further characteristics as you pursue the diagnosis.

Lesion

Choose the right efflorescences:

Vesicle

Crust

Scar

Node (also cyst)

Macule

Diagnosis

Choose the right diagnosis:

Syphilis

Lymphogranuloma venereum (LGV)

Candidiasis

Hidradenitis Suppurativa

Chancroid

Therapy

Choose the right therapy(ies):

Surgical intervention (incision and drainage), or perhaps radical excision, as well as broad-spectrum antibiotic coverage.

No therapy is needed, as the disorder is harmless and self-limited.

Disinfectant dressings with melaleuca oil (tea tree oil), bacterial culture and systemic antibiotics (doxycycline 100 mg b.i.d. for 14 days).

Admission to hospital and systemic therapy with cyclosporine (3 mg/kg daily).

Surgical intervention (incision and drainage), bacterial culture and systemic antibiotics (amoxicillin/ clavulanic acid 625 mg t.i.d. for 7 days).

Test

The following questions are related to the current case. Try to solve them.

Question 304

Type: KPrim

Peripheral circulatory disturbances with signs such as acrocyanosis and cutis marmorata are possible signs of a predisposition for:

Question 301

Type: E

Statement 1 Hidradenitis suppurativa can on rare occasion lead to bladder or rectal fistulas

Question 300

Type: E

Statement 1 Deodorants are a proven trigger for hidradenitis suppurativa

Question 299

Type: A

What are typical locations for hidradenitis suppurativa?

Question 296

Type: A

Which of the following statements about hidradenitis suppurativa are true?

Simple cases

Case 59

History

Lesion

Diagnosis

Therapy

Test